Carers Resilience Enablement Grant Application Form Carers Resilience Enablement Grant Application Step 1 of 11 9% About this grant In order for us to accept your application, you need to have a reference from a support worker from one of the following organisations: Cornwall Carers Service Inclusion Matters Your support worker will need to complete the reference found on the grant's home page or contact us for a copy. We cannot accept any application without the endorsement of a support worker. If you do not currently have a support worker, you can call 01736 756655 and ask to be referred to Cornwall Carers Service for help with this grant.About this form Please note, this application form can be saved partway through. Please click the Save and Continue Later link at the bottom of any page. You will be asked to supply your email address and you will be emailed a link to your application form so that you can continue to complete it at a later date. Data Protection CRCC complies with the EU General Data Protection Regulations and the Data Protection Act 2018. By sending this form to us, you agree that we can securely store your personal information on our database or in the form of paper records, and that we can use your information in order to provide a service to you as part of the Wellbeing Community Grants Programme. We will only collect and process information in accordance with the legal basis for the service you are receiving. We will not sell your information or share it with any other organisations. We will not keep this information longer than necessary (this is normally for two years following the end of the contract year); it will then be securely destroyed. Our full Privacy Statement is available on request and can be viewed on our website at www.cornwallrcc.org.uk/policies-procedures If you wish to withdraw your consent, or if you wish to see a copy of the information we hold about you, please forward your request to the Grants and Compliance Lead on 07715 799395 or email dataadmin@cornwallrcc.org.uk Have you read and understood the Terms and Conditions that accompany this application form?* Yes No - please get in touch with us with any queries before continuing Name of carer* Contact address and postcode*Daytime telephone number* Email* About your caring roleHow many people do you care for?*No of adultsNo of children under 18 Can you tell us about the impact of your caring role on your daily life and on your health and wellbeing?*Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information.Please tick if you would like us to send you information on either of these servicesCornwall Carers Service can provide carers with advice and guidance, advocacy, the opportunity to meet with a Carer Wellbeing Practitioner and information about benefits Inclusion Matters can provide information and advice to increase well-being and connection to your community. Cornwall Carers Service Inclusion Matters About your funding requestPlease note the maximum funding request permitted per category Repair or replacement of essential domestic equipment; funding for private care equipment: other urgent domestic need No limit but only reasonable costs permitted Emergency local break for carer and supported person: Max £100 per personWhat are you requesting funding for?* Repair or replacement of essential domestic equipment; funding for private care equipment; other urgent domestic need Urgent break Funding request for repair or replacement of essential domestic equipment; funding for private care equipment • Request must be for items that, without them, you would be unable to fulfil your caring role, and where you have been unable to secure funding from elsewhere. • Funding requests will be assessed by a grant panel and only awarded if costs are deemed to be fair and reasonable. We would need to see a full statement from your support worker to explain how all other funding options are not available. What do you need?* Repair of essential domestic equipment Replacement of essential domestic equipment Funding for private care equipment Other urgent domestic need Please tell us more about what you would like funding for, e.g. item and reason for requesting funding*Please explain how you are prevented from adequately fulfilling your caring role as a result of not having this item?*Please explain why other funding options are unavailable or not applicable*Funding request for an urgent break for a carer and supported person in Cornwall • Activities must give you and the person you care for a break, helping you to find some relaxation, so that you are able to stay in your caring role for longer, e.g. entrance fees to a National Trust garden, overnight accommodation at a local B&B. • Please tell us what, where and when they will take place. • Activities must take place before 30 June 2022. If you do not have a specific date booked, please give an approximate time, e.g. July. Your funding request*What is the activity?Where will this take place?When? Who else, apart from you, will be taking part?*Please tick all that apply Adult you care for Child under 18 you care for Please explain how this activity will improve your quality of life* Costings Please provide below a detailed list of costs that you would like the grant to fund. We need to know ‘what’, ‘how many’, ‘how much’, etc. If you have it, please submit evidence of these costs with your application. We need to know how you worked out your costs so please send us quotes, website addresses, etc. You can either upload documents below or email them separately to grants@cornwallrcc.org.uk If you cannot supply evidence you need to tell us why. Breakdown of costs*Please list each item or activity on separate rows. To add extra rows, click on the + symbol at the end of the row you've just completed.Name of itemPlease give evidence of cost for each item requested (including delivery, connection & recycling if necessary) e.g. quote, screenshot, link to websiteTotal cost Breakdown of costs*Please list each item or activity on separate rows. To add extra rows, click on the + symbol at the end of the row you've just completed.Name of activityHow many? E.g. 2 peopleCost per person/ sessionTotal cost Please use this box to detail any website addresses that evidence where you got your costings from, if applicable.Please note, we cannot accept Facebook pages as evidence of costs. Your webpage link must take us directly to one/some of the costs you are listing aboveIf you wish to upload evidence of costs please do so here.You can upload multiple documents if you need to Drop files here or Select files Max. file size: 64 MB. Your bank details If your application is successful, payment will be made directly into your bank account. Bank or building society* Name of Account Holder (as it appears on your account)* Account number* Sort code* Carers applying to this grant must be referred by a recognised service that supports carers. All applications must have the endorsement of one of these services. Please ask your referee to complete the reference request found on the Carers Resilience Enablement Grant homepage . Unfortunately, we are unable to accept applications without this endorsement. Please either ask your support worker to complete the reference online (please see this grant's homepage} or they can download a reference form from the homepage and then send it to us by email to grants@cornwallrcc.org.uk It is your responsibility to ensure we receive your reference before the application deadline. Name of your referee/ support worker* Please tick which organisation they work for*Must be someone from one of the organisations below Cornwall Carers Service Inclusion Matters Declaration and agreement*Please tick all boxes to indicate your agreement I agree to the Terms and Conditions of the Carers Resilience Enablement Grant as they are set out in the guidelines that accompany this application form. I will only use the grant for the items or activities stated in my application or I must get permission from CRCC first to make any changes. I understand that any repairers/ suppliers must, where possible, be based in Cornwall. I understand that if CRCC is not satisfied with how the money has been used we may be asked to repay some or all of the grant. I am submitting evidence of the costings relating to the items/activity that we are requesting a grant for, e.g. quotes or website addresses, etc. I understand that this grant cannot be used for items/activities already paid for. I understand that the grant award must be spent by 30 June 2022 I agree to complete a feedback report on how the grant was spent and how it has helped the group, and agree to send in all relevant receipts. All feedback reports and receipts must be sent back to CRCC within one month of the stated activity. I have read the Data Protection statement in the Terms and Conditions and agree to how CRCC will hold/use my details. I confirm that the information provided in this application is true and accurate to the best of my knowledge. Date* DD slash MM slash YYYY Would you like to join our mailing list?*We occasionally send out emails to advise people of events and services that may be of interest to them, including updates on grant programmes. You can choose from the list below which type of emails you would be interested in receiving. You can unsubscribe at any time using the link at the bottom of each email. We will not share your name and email address with any other party. Click here to read our Privacy Statement Yes please No thank you Please select your mailing list preferences*Please tick ALL that apply Grants - we will only contact you with information about our grant programmes Other CRCC info - receive occasional emails about other services we offer About other approved services and organisations Important reminder Please note all activities must take place before 30 June 2022 All grant monies must be spent by 30 June 2022. Feedback reports must be sent back within 4 weeks of the final activity using the template provided.Next steps Please save a copy of this completed form for your own records. You may need to refer to your application form if we have any queries and you will need to refer to it when completing a feedback report. A copy will be emailed to you after you click SUBMIT Additional information If you need to call us, our number is: 01736 756655 Our email address is: grants@cornwallrcc.org.uk
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